ROUTINE URINALYSIS Appearance and Color of Urine

USTMED ’07 Sec C - AsM

Apprnce Cause Remarks
Components of a Urinalysis Colorless Very dilute urine Polyuria, diabetes insipidus
Physical Examination of Urine Cloudy Phosphates, carbonates Soluble in dilute acetic acid
1. color Urates, uric acid
2. transparency Leukocytes Dissolve in 60oC and in alkali
3. specific gravity Red cells (“smoky”) Insoluble in dilute acetic acid
4. pH bacteria, yeasts Lyse in dilute acetic acid
Chemical Examination of Urine (using a multi-parameter reagent spermatozoa Insoluble in dilute acetic acid
strip) prostatic fluid Insoluble in dilute acetic acid
1. Protein mucin, mucous threads
2. Glucose calculi, “gravel” May be flocculent
3. Ketone clumps, pus, tissue Phosphates, oxalates
4. Bilirubin fecal contamination
5. Hemoglobin radiographic dye Rectovesical fistula
6. Urobilinogen In acid urine
7. Nitrite Milky Many neutrophils Insoluble in dilute acetic acid
8. Leukocyte esterase (pyuria)
Microscopic Examination of Sediments Fat
Lipiduria,opalascent Nephrosis, crush injury –
Collection and Handling of Urine Specimen soluble in ether
Urine must be collected in a clean, dry container. Disposable Chyluria, milky Lymphatic obstruction –
containers are recommended in order to reduce bacterial soluble in ether
contamination. Emulsified paraffin Vaginal creams
Yellow Acriflavine Green Fluorescence
Label the specimen container w/ the patient’s name, date and Yellow- Concentrated urine Dehydration, fever
time of collection. Place the label on the container and not on the orange Urobilin in excess No yellow foam
lid. Bilirubin Yellow foam, if sufficient
bilirubin
Urine collected should be sent to the lab as soon as possible and Yellow- Bilirubin-biliverdin Yellow foam
should be tested w/in 1 hr. Refrigeration is necessary if the urine green
cannot be delivered immediately to the laboratory or cannot be Yellow- Bilirubin-biliverdin “beer” brown, yellow foam
tested w/in 1 hr. The addition of a chemical preservative can also brown
be done.
Red Hemoglobin Positive reagent strip for
blood
Types of urine specimens
Erythrocytes Positive reagent strip for
1. random specimen
blood
– most commonly received specimen
Myoglobin Positive reagent strip for
2. First morning urine
blood
- the ideal screening specimen
Porphyrin May be colorless
- used for routine screening, pregnancy tests and for
Fuscin, aniline dye Foods, candy
determining orthostatic proteinuria
Beets Yellow alkaline, genetic
3. Fasting Specimen (Second Morning Specimen)
Menstrual Clots, mucus
- second voided urine specimen used for glucose
contamination
monitoring
Red-purple Porphyrins May be colorless
4. 24-hour specimen
- timed specimen is used to determine concentration Red-brown Erythrocytes
of a particular substance Hemoglobin on
- Instruction: standing
o Day 1 – 7am - patient voids and Methemoglobin Acid pH
Myoglobin Muscle injury
discards specimen
Bilifuscin (dipyrrole) Result of unstable
- patient collects all urine
hemoglobin
for the next 24 hours
o Day 2 – 7am - patient voids and adds Brown- Methemoglobin Blood, acid pH
black Homogentisic acid On standing, alkaline
this urine to the previously
Melanin On standing, rare
collected urine
Blue-green Indicans Small intestine infection
5. Catheterized Specimen
Pseudomonas
- used for bacterial culture
infections
6. Midstream Clean-Catch Specimen
Chlorophyll Mouth deodorants
- an ideal specimen for routine screening and for
bacterial culture
- patient is instructed to cleanse thoroughly the
genitalia and is asked to collect the midstream Color
portion of urine. When collecting, patient should Normal urine color – Yellow (due to urochrome)
be instructed to separate the labia in females or
retract the foreskin in uncircumcised males. Color Pathologic NonPatho Drugs
7. Suprapubic Aspiration Orange Bilirubin Rhubarb Phenazopyridine
- used for bacterial culture and cytology Carrots
- sterile needle is introduced into the bladder to Dark Yellow Bilirubin Carrots Fluorescein
collect sample that is free of contaminants Urobilin Concentrated
8. Pediatric Specimen Green Oxidized Vit B complx Dithiazanine
- soft, clear plastic bag w/ adhesive is attached to bilirubin Nitorfurans
the genital portion Biliverdin Phenol
Pseudomonas
PHYSICAL EXAMIANTION OF URINE Red or Pink RBCs Beets Benzene
Hemoglobin Acetophenetidin
Odor Myoglobin Phenindione
- usually not a part of routine urinalysis Porphyrins
- ammoniacal odor of urine is due to breakdown of urea Brown or Biliary Rhubarb Phenol
Odor Pathologic Nonpathologic Black pigments derivatives
Ammonia UTI Old urine Melanin Methyldopa
Sweet Diabetes mellitus Starvation, dieting, Hmogentisic Levodopa
strenuous exercise, acid
vomiting, diarrhea Pale Yellow Diabetes Large fluid Diuretics
Mousy Phenylketonuria mellitus intake
Maple syrup Maple syrup disease Diabetes
Distinctive Garlic, onions, insipidus
asparagus
Transparency (clarity)
Normal appearance Formula: Au x Cs = Cu in mg/dl 0.16 x 50 = 40 mg/dl
- freshly voided urine is usually clear As 0.20
- white cloudiness may be caused by precipitation of
amorphous phosphates and carbonates
Causes of turbidity Urine Total Protein (mg/24 hrs or g/24 hrs)
- presence of phosphates, carbonates, crystals
- red blood cells, leukocytes, epithelial cells, etc. Urine Total Protein = Au x Cs x Volume in dl (24 hr urine)
As
Specific Gravity
- defined as the density of a substance compared with the To convert mg/dl to g/L: Divide
density of a similar volume of distilled water at a similar computed value by 100 or multiply
temperature by 0.01
- used to assess kidney’s ability for reabsorption
- Normal values = 1.015-1.025 Example-
Au = 0.12
ROUTINE URINALYSIS PROCEDURE As = 0.08
Urine in specimen container Cs – 50 mg/dl
Urine volume = 10 dl or 1 L
Transfer urine in a clean tube
Urine Total Protein = 0.12 x 50 mg/dl x 10 dl
Step 1 Physical Examination 0.08
*note color & transparency
*specific gravity & pH will be done using the Multistix (Step)2 = 1.5 x 50 mg/dl x 10 df

Step 2 Chemical Examination = 750 mg/24 hrs

* use Multistix Reagent Strip and test for glucose, bilirubin,
ketones, specific gravity, blood, pH, protein, Urobilinogen, nitrite to convert to g/24 hrs: Divide by 1000
& leukocytes
= 0.75 g/24 hrs
Centrifuge for 5 mins
Normal Values
Decant supernatant & place a drop of the sediments onto a slide Random urine = 0.01 – 0.14 g/L
Urine Total protein = up to 0.15 g/24 h4s
Step 3 Microscopic Examination
*examine under LPO & HPO and B. Microalbumin
write your findings in the result form An immunological, semi-quantitative determination of
mcroalbuminuria up to 100 mg/L

QUANTITATIVE DETERMINATION OF TOTAL PROTEIN IN URINE Principle:

Immunological detection of human albumin. The absorbed urine
A. Pyrogallol Red-Molybdate Method enters a zone on the strip containing a soluble antibody-gold-
conjugate which specifically binds to urine albumin. Excess
Clinical Significance: conjugate is retained in a separation zone containing immobilized
Urinary protein determinations are important in the evaluation of human albumin so that only the albumin-loaded gold conjugate
kidney function. The detection of protein in urine is considered reaches the detection zone. The color produced (white to red) is
evidence of renal disease and usually of glomerular disease. A directly related to the albumin content of the urine. Cross-
minor evaluation of urinary albumin excretion from about 15-30 reactions with other human proteins such as hemoglobin,
mg/day is now recognized to be a useful indicator of renal transferring, Bence-Jones protein, α1-antitrypsin, acidic-α1-
disease. glycoprotein, α-amylase, Tamm-Horsfall protein and retinol-
binding protein, as well as with IgG, IgA, human leukocytes and
Principle: erythrocytes have been found to be <0.5%.
The Total Protein Test for Urine is based on the procedure
developed by Watanabe et al which is a dye-binding colorimetric Application:
method utilizing pyrogallol red-molybdate complex. For early detection and monitoring the course of incipient
nephropathy in e.g. diabetics and hypertensive patients.
The pyrogallol red is combined w/ molybdenum acid, forming a Microalbuminuria denotes as albumin excretion of 20-200 mg/L.
red cplx w/ maximum abs at 467nm. When this cplx is combined
w/ protein in acidic conditions, a blue-purple color develops w/ Test Component
an inc in abs to 598nm. One test strip contains: Monoclonal antibodies against human
albumin (Immunoglobulin G) labeled with colloidal gold: 2.2ug,
Reagents: fixed albumin: 7.7 ug.
1. PRM color reagent
• pyrogallol red-molybdate soln buffered at pH 2.2 Ideal Specimen:
2. Microprotein standard First morning urine
• (50 mg/dl) a soln of bovine serum albumin with
preservative Results:
Reaction colors lighter than the color block corresponding to
Specimen Collection & Handling: approx 20 mg/L albumin indicate a physiological urine albumin
Urine – random or 24 hr urine collection. Keep specimen cold conc.
during collection.
Analyze fresh. Stable frozen at -20oC for up to one year. The result is positive (i.e. indicates persistent microalbuminuria)
when at least two of the three morning urines tested produce a
Procedure: reaction color corresponding to 20 mg/L (Threshold value of
Unknown Standard Blank microalbuminuria) or more.
PRM reagent 3.0 ml 3.0 ml 3.0 ml
Serum 0.1 ml - - Determination of albumin concentrations above 100 mg/L
In order to determine albumin conc above 100 mg/L, the urine
Protein Standard - 0.1 ml -
sample can be diluted e.g. by mixing 1 part of urine with 2 parts
Distilled water - - 0.1 ml
water. The original albumin concentration is then calculated by
Allow to stand at room temperature for 20 mins multiplying the result by 3.
Set wavelength of the photometer at 600 nm and zero with the
BLANK. Read and record readings of remaining vials.

Computation:
Example-
Au = Abs of Unknown Au = 0.16
As = Abs of Standard As = 0.20
Cu = Concentration of Unk Cu = ?
Cs = Conc of Standard Cs = 50 mg/dl
CHEMICAL EXAMINATION OF URINE
COMBISTIX / MULTISTIX Multiple Reagent Strips for Urinalysis
Semi-quantitative determination of the following parameters:
Specific gravity Bilirubin
pH Hemoglobin/Myoglobin
Albumin Urobilinogen
Glucose Nitrite
Ketone Esterase
Specimen Collection and Preparation:
Use a freshly voided, well-mixed uncentrifuged urine specimen,
collected in a clean container. If testing is not possible one hour
after voiding, refrigerate specimen and return it to room
temperature before testing. No preservative will prevent
deterioration of ketones, bilirubin or urobilinogen, if certain
contaminating organisms are present, they may metabolize
glucose. Always handle specimen under sanitary conditions.
Contamination of urine sample with chlorhexidine antiseptic will
give false-positive reading for protein.
Procedure: MUST BE FOLLOWED EXACTLY TO ACHIEVE RELIABLE
TEST RESULTS
1. collect FRESH urine specimen in a clean, dry container.
Mix well immediately before testing.
2. remove one strip from bottle and replace cap.
Completely immerse reagent areas of the strip in FRESH
urine and remove immediately to avoid dissolving out
reagents
3. While removing, run the edge of the strip against the
rim of the urine container to remove excess urine. Hold
the strip in a horizontal position to prevent possible
mixing of chemicals from adjacent reagent areas/or
contaminating the hands with urine.
4. Compare reagent areas to corresponding Color chart on
the bottle label at the time specified. Hold strip close to
color blocks and match carefully. Avoid laying the strip
directly on the Color chart as this will result in the urine
soiling the chart
For optimal results, read the ketone test at 15 seconds
after dipping; read the bilirubin test at 20 seconds;
glucose at 30 seconds; blood at 40 seconds; urobilinogen
at 45 seconds; and specific gravity from 45 to 60 seconds
after dipping.
Specific Gravity
Urobilinogen
This test is based on the coupling of biilrubin w/ diazotized
dichloroaniline in a strongly acid medium yielding various shades
of tan. Normally, no bilirubin is detectable in urine by even the
most sensitive tests, so any positive result calls for further
investigation. The test has a sensitivity of 7-14 umol/L bilirubin.
Colors that do not match the color blocks may result from the
presence of bile pigments other than bilirubin, indicating bile
pigment abnormalities and suggesting the need for further testing
with ICTOTEST reagent tablet, which are 2 to 4 times more
sensitive than the strip test. (If the presence of very small conc of
bilirubin is suspected, as in early phases of live disease, ICTOTEST
should be used.) Specimens from patients receiving large doses of
chlorpromazine may give false positive results. Metabolites of
drugs such as Pyridium and conc of 1.4 mmol/L or greater may
cause false negatives.
III. Glucose (30 secs for quantitative results)
Principle: Glucose oxidase, double sequential enzyme rxn
Glucose oxidase converts glucose to gluconic acid and
hydrogen peroxide. Peroxidase then catalyzes the rxn of hydrogen
peroxide w/ a potassium iodide (KI) chromogen to form a green to
brown color.
Reagent Composition:
Glucose oxidase, peroxidase, potassium iodide, buffer, non-
reactive ingredients.
In a double sequential enzyme rxn, glucose oxidase converts
glucose to gluconic acid and hydrogen peroxide. Peroxidase then
catalyzes the rxn of H2O2 w/ KI chromogen to form a green to
brown color. This test yields negative results w/ normal urines.
Significant abnormality may be indicated by results of as little as 5
mmol/L if found consistently. High specific gravity, low
temperature or moderately high amounts of ketones (4 mmol/L
acetoacetic acid or greater) may cause false negatives in
specimens containing small amounts of glucose (5 mmol/L).
However, the combination of such high ketone levels and low
glucose levels is metabolically improbable in screening. Ascorbic
acid concentrations of 2.9 mmol/L or greater may cause false
negative for specimens containing small amounts of glucose (5
mmol/L). At glucose levels of 60 mmol/L or greater the color may
appear uneven. Use the darkest color appearing on the reagent
area to interpret the results.

IV. Blood (40 seconds) 60 seconds on the table…

Leucocytes

Bilirubin

Glucose
Protein

Ketone
Nitrite

Blood
pH

Principle: Peroxidase-like activity of hemoglobin

Catalyzes the reaction of cumene hydroperoxide and
tetramethylybenzidine

Note: the appearance of green spots on the reacted reagent area

indicates the presence of intact red cells in the urine.
I. Ketone (15 secs) 40 seconds nakalagay sa table…??? Reagent Composition:
Cumene hydroperoxide, tetramethylbenzidine

This test is based on the peroxide-like activity of hemoglobin

w/c catalyzes the rxn of cumene hydroperoxide and 3,3’,
Principle: Sodium Nitroprusside Rxn 5,5’-tetramethylbenzidine. The resulting color ranges from orange
through green to dark blue. Blood is often but not always found in
The test is based on the development of colors ranging from the urine of menstruating females. The test is generally capable
buff pink for negative reading to maroon when acetoacetc acid of detecting 150-620 ug/L free hemoglobin (or 5 to 20 intact red
reacts with nitro-prusside. Normally no ketones are present in blood cells per microliter) in urines w/ specific gravity of 1.005
urine. As little as 0.5-1 mmol/L acetoacetic acid is detectable. and ascorbic acid concentrates of < 0.3 mmol/L and is less
Positive results (trace or less) may occur with highly pigmented sensitive in urines with higher specific gravity or greater ascorbic
urine specimens or those containing large amounts of L-Dopa acid content. The test is slightly more sensitive to free
metabolites. hemoglobin and myoglobin than to intact red cells. The
appearance of green spots on the reacted reagent area indicates
Reagent Composition: the presence of intact red cells in the urine. Certain oxidizing
Sodium nitroprusside contaminants such as hypochlorite and microbial peroxidase
associated with urinary tract infection, may cause false positive
II. Bilirubin (20 secs) 30 seconds on the table… results.

V. Urobilinogen (45 seconds) 60 seconds ulit…

Principle: Diazo reaction

Coupling of bilirubin w/ diazotized dichloroaniline in a
strongly acid medium yielding various shades of tan.
Principle: Ehrlich reaction
Reagent Composition: p-dimethly-amino-benzaldehyde reacts w/ urobilinogen in a
2,4 dichloroaniline diazonium salt strongly acid medium to form a brown orange color.

Reagent Composition:
Para-dimethylaminobenzaldehyde
This test is based on the Ehrlich reaction in which p-
dimethyl-amino-benzaldehyde reacts w/ urobilinogen in a strongly
acid medium to form a brown orange color. In healthy population,
the normal urine urobilinogen range is 1.6-16 umol/L urobilinogen.
The absence of urobilinogen in the specimen cannot be
established. The test will react w/ interfering substances known
to react w/ Ehrlich’s reagent, such as p-aminosalicyli acid. Drugs
containing azo dyes may give a masking golden color. This test is
not a reliable method for the detection of prophobilinogen.
VI. Specific Gravity (45-60 seconds)
protein and mucoprotein, so a negative result does not rule out
the presence of these proteins. False positive results may occur
w/ alkaline, highly buffered urines or in the presence of
contaminating quaternary ammonium compounds.
IX. Nitrite (60 seconds)
Principle: Greiss reaction
Conversion of nitrate (derived from diet) to nitrite by the
action of principally Gram negative bacteria in the urine
Reagent Composition:
p-arsanilic acid, tetrahydrobenzo(h)-quinolin-3-ol

This test depends upon the conversion of nitrate (derived from

diet) to nitrite by the action of principally Gram negative bacteria
in the urine. The test is specific for nitrite and will not react w/
Principle:
any other substance normally excreted in urine. Pink spots or pink
This test is based upon the ionic conc of urine. The pKa’s of
edges should not be interpreted as positive result. Any degree of
certain pretreated polyelectrolytes change in relation to the ionic
uniform pink color development should be interpreted as a
conc of the urine. In the presence of an indicator, colors range
positive nitrite test suggesting the presence of 105 or more
from deep blue-green in urine of low ionic conc through green and
organisms per mL, but color development is not proportional to
yellow-green in urines of increasing ionic conc.
the number of bacteria present. A negative result does not in itself
prove that there is not significant bacteriuria. Negative results
A lower S.G. reading
may occur when UTI are caused by organisms w/c do not contain
- highly buffered alkaline urines
reductase to convert nitrate to nitrite; when urine has not been
- urines containing glucose or urea at conc of > 1%
retained in the bladder long enough (4 hrs or more) for reduction
of nitrate to occur; or when dietary nitrate is absent, even if
Elevated S.G. readings
organisms containing reductase are present and bladder
- presence of moderate 91.0-7.5 g/L) qty of protein.
incubation is ample. Sensitivity of the nitrite test is reduced for
urines w/ high specific gravity. Ascorbic acid conc of 1.42 mmol/L
S.G. readings correlate with values obtained by the
or greater may cause false negative results w/ specimens
refractive index method. A lower S.G. reading, relative to the
containing small amts of nitrite ion (13 umol/L or less).
other methods, may be caused by highly buffered alkaline urines
and urines containing glucose or urea at conc of > than 1%.
X. Leukocytes (2 minutes)
Elevated S.G. readings, relative to other methods, may be
obtained in the presence of moderate (1.0-7.5 g/L) qty of protein.
Random urines may vary in S.G. between 1.003-1.040. This S.G.
test permits determination of urine S.G. between 1.000-1.030. For
increased accuracy, 0.005 may be added to readings from urines Principle:
with pH equal or greater than 6.5. Granulocytic leukocytes contain esterases that catalyze the
hydrolysis of the derivatized pyrrole amino acid ester to liberate
Reagent Composition: 3-hydroxy-5-phenyl pyrrole. This pyrrole then reacts w/ a
Bromthymol blue, poly (methyl vinyl ether maleic anhydride), diazonium salt to produce a purple product.
sodium hydroxide
Reagent Composition:
VII. pH (may be read immediately – timing not critical) Derivatized pyrrole amino acid ester, diazonium salt

MICROSCOPIC ANALYSIS OF URINE

Principle: Double indicator system
Gives a range of colors from orange through yellow and green
to blue and permits differentiation to w/in 0.5 pH units in the
range pH 5 to pH 8.5.

Reagent Composition:
methyl red, bromthymol blue, nonreactive ingredients

This test is based on the double indicator system principle.

Readings are not affected by variations in urinary buffer
concentration, but contamination by reagent washed from an
overwetted adjacent reagent area may affect results.
VIII. Protein (may be read immediately – timing not critical)
1. Fresh or adequately preserved urine specimen
(approximately 10-15 m) is placed preferably on a
conical tube and centrifuged for 5 minutes.
2. Decant supernatant and the sediment is resuspended
with the remaining urine in the tube (usually 0.5 mL or
1.0 mL)

Principle: Protein-error-of-indicators
The presence of protein results in development of a green
color

Reagent Composition:
Tetrabromphenol blue, buffer, non-reactive ingredients.

Note: contamination of the urine sample w/ chlorhexidine

antiseptic will give a false-positive reading for protein.

The test is based on the protein-error-of-indicators principle.

The presence of protein results in development of a green color
(echo!). The test yields negative results w/ normal urines, so any 3.
positive result greater than “Trace” indicates significant
proteinuria. Clinical judgment may be used to interpret “Trace” 4.
results, w/c may occur w/ urines of high specific gravity w/ non- 5.
significant protein-uria. The “trace” result corresponds to 0.05-0.2
g/L albumin, but the test is less sensitive to globulin, Bence-Jones
Using a pipet, place a drop of resuspended sediment on
a clean slide and cover with a cover slip
Examine the sediment first using the LPO
Shift to HPO to identify specific types of cells, casts,
bacteria and crystals
Manner of Reporting: porcelain plate. Apply a small portion of a collected
stool specimen to the HEMATEST filter paper w/ an
Elements Report As applicator stick. The smear should be a thin, narrow
RBCs and WBCs Average of RBC or WBC seen in 10 high power streak. Do not use an emulsion or suspension.
fields (HPF) 2. place the tablet on the specimen so that part of the
Casts Average casts seen per cover slip ( __/cs) tablet is directly touching the clean filter paper
Epithelial cells Report as: 3. Place one drop of distilled water on the tablet. Allow 5-
few, occasional, moderate, many or 10 secs for the water to penetrate the tablet. Then add
+,++,+++,++++ a second drop so that the water runs down the side of
Crystals Report as: the tablet onto the specimen filter paper. If necessary,
Other elements few, occasional, moderate, many or gently tap side of plate once or twice to dislodge water
(Bacteria, +,++,+++,++++ from top of tablet.
yeasts) 4. For up to two minutes, observe filter paper for
appearance of any trace of blue color surrounding the
Read under LPO tablet. Ignore color that develops on or directly under
the tablet itself and any color appearing on the filter
Report As
paper after the 2-minute time.
Casts
Hyalin
Results:
Granular # of casts seen/ cover slip
A positive rxn is indicated by
Waxy
the appearance of any trace of
Pus cell
blue color on the filter paper
RBC
around the tablet w/in the 2-
minute reading time. Ignore any
Cells
color that develops on or directly
Squamous cells Few, occasional, moderate or
under the tablet itself and any
Renal cells many OR
color appearing on the filter
Mucus threads +, ++, +++, ++++
paper after the two-minute time.
Crystals
Neutral Fat Estimation (Sudan III Staining)
Amorphous urates Few, occasional, moderate or
Uric acid many OR
Procedure:
Calcium oxalate +, ++, +++, ++++
1. mix stool specimen thoroughly w/ an applicator stick
Amorphous PO4
2. place a small amt (2-3 mm) on a clean glass slide.
Triple PO4
Emulsify w/ a drop of ethyl alcohol.
Read under HPO
3. add 2 drops of sudan stain
RBC Average of RBC/WBC seen in 10
WBC fields/HPF 4. mix and apply cover slip
Yeast cells Few, occasional, moderate or 5. let stand for 5 mins and examine microscopically
Bacteria many OR
+, ++, +++, ++++ Interpretation:
Presence of neutral fat
droplets is indicated by yellow-
ROUTINE FECALYSIS orange to red globules which tend
to collect at the edges of the
There is no substitute for careful visual inspection of the patient’s cover slip. In normal stools, there
stool by the physician. Patient’s descriptions of their feces are are less than 50 fat
subjective and inaccurate. globules/highly power field by
microscopic examination.
Routine Fecal Analysis:
Laboratory examination of feces is most commonly employed for: Fecal Trypsin Determination
1. Detection of gastrointestinal bleeding
2. Confirmation of steatorrhea Principle:
3. Detection and identification of parasites x-ray film strips are immersed in diluted fecal emulsions.
Proteolytic activity (of trypsin and chymotrypsin) causes digestion
Specimen Collection: of the gelatin emulsion on x-ray film
A well-ringed bed pan is a convenient collecting vessel. A
cleaned, rinsed and boiled glass jar provides a satisfactory Procedure:
alternative. Female patients must be warned not to contaminate 1. mix duodenal content or a pea-sized fecal material in a
the specimen w/ urine since urine has harmful effects on test tube w/ 2% sodium carbonate (about 0.5 ml)
protozoa. Patients must also be instructed not to overfill and 2. place a small amount of gelatin square (xray film) into
contaminate the container. the mixture and incubate at 37oC
Stool collected w/in 72 hrs after barium enema or swallow is
unsatisfactory. Similarly, stool from patient taking mineral oil is Interpretation:
undesirable. Complete digestion of gelatin
is recognized by complete clearing
Detection of Fecal Occult Blood Using Hematest Reagent Tablets of x-ray film (the blue tint of the
film base should be apparent).
Principle: Partial digestion is indicated by
The test is based on the peroxidase-like activity of mixed clear and cloudy film. When
hemoglobin in catalyzing the oxidation by peroxide of a there is no digestion, the gelatin
chromogen, tetramethylbenzidine, to form a blue color. remains intact.

Reagent:
Tetramethylbenzidine, strontium peroxide -fin-

Specimen Collection and Preparation: arrrrgggggghhhhhh!!!!!!

Collect fecal specimen uncontaminated w/ urine and test as
soon as possible. When testing collected specimens, it is
recommended that several segments or portions of the stool be
tested; blood from colo-rectal bleeding may be predominantly on
the outer surface of the formed stool, and blood from upper
portions of the GI tract is not always uniformly dispersed
throughout the specimen. A meat-free diet prior to specimen
collection is desirable to minimize false positive reactions that
can result from ingestion of raw or rare meat. Intake of Vit. C
should be restricted because ingestion of large quantities may
result in false negative results.
Procedure:
1. Place HEMATEST filter paper on a clean glass or Sample Urine Results with corresponding diagnosis
 Urinalysis Result Form
Urinalysis Result Form
Physical Characteristics Microscopic Findings
Physical Characteristics Microscopic Findings
Color: reddish Casts:
Color: reddish Casts: Transparency: turbid Hylaine: 3 / cs
Transparency: turbid Hylaine pH: 7.0 Granular: 12 / cs
pH: 6.0 Granular Specific Gravity: 1.030 Waxy
Specific Gravity: 1.026 Waxy Pus Cell
Pus Cell RBC
RBC Chemical Test Cells:
Chemical Test Cells: Glucose: negative RBC: 0-2 / HPF
Glucose: negative RBC: 50-60 / HPF Bilirubin: negative Pus Cell: 1-3 / HPF
Bilirubin: negative Pus Cell: 1-30 / HPF Ketone: negative Yeast Cell
Ketone: negative Yeast Cell Blood: +++ Squamous Cells: few
Blood: ++ Squamous Cells: few Protein: ++ Renal Cells
Protein: ++ Renal Cells Urobilinogen: negative Bacteria
Urobilinogen: negative Bacteria Nitrite: negative Mucus Threads
Nitrite: negative Mucus Threads Leucocyte esterase: negative Crystals:
Leucocyte esterase: negative Crystals: Amorphous urates: few
Amorphous urates: few Uric Acid:
Uric Acid: ++++ Calcium Oxalate
Calcium Oxalate Amorophous PO4
Amorophous PO4 Triple PO4
Triple PO4
Diagnosis: Acute Immune-mediated Blood Transfusion Reaction
Diagnosis: Ureterolithiasis (Uric Acid), Right

Urinalysis Result Form Urinalysis Result Form

Physical Characteristics Microscopic Findings Physical Characteristics Microscopic Findings

Color: dark yellow Casts: Color: yellow brown Casts:

Transparency: turbid Hylaine: 20 – 25 /cs Transparency: turbid Hylaine
pH: 6.0 Granular: 15-20 / cs pH: 6.0 Granular
Specific Gravity: 1.030 Waxy Specific Gravity: 1.030 Waxy
Pus Cell Pus Cell
RBC > 50 / cs RBC
Chemical Test Cells: Chemical Test Cells:
Glucose: negative RBC: 50-60 / HPF Glucose: negative RBC: 0-1 / HPF
Bilirubin: negative Pus Cell: 2-4 / HPF Bilirubin: negative Pus Cell: 0-2 / HPF
Ketone: negative Yeast Cell Ketone: negative Yeast Cell
Blood: + Squamous Cells: few Blood: negative Squamous Cells: few
Protein: +++ Renal Cells: few Protein: trace Renal Cells
Urobilinogen: negative Bacteria Urobilinogen: negative Bacteria
Nitrite: negative Mucus Threads Nitrite: negative Mucus Threads: few
Leucocyte esterase: trace Crystals: Leucocyte esterase: negative Crystals:
Amorphous urates: few Amorphous urates: few
Uric Acid: Uric Acid:
Calcium Oxalate Calcium Oxalate
Amorophous PO4 Amorophous PO4
Triple PO4 Triple PO4

Diagnosis: Acute Glomerulonephritis Diagnosis: Cholelithiaasis (obstructive jaundice)

Urinalysis Result Form Urinalysis Result Form

Physical Characteristics Microscopic Findings Physical Characteristics Microscopic Findings

Color: yellow Casts: Color: yellow Casts:

Transparency: turbid Hylaine: 2-4 / cs Transparency: turbid Hylaine: 0-1 / cs
pH: 5.0 Granular: 4-6 / cs pH: 6.0 Granular: 0-1 / cs
Specific Gravity: 1.035 Waxy Specific Gravity: 1.028 Waxy
Pus Cell: > 50 / cs Pus Cell
RBC RBC
Chemical Test Cells: Chemical Test Cells:
Glucose: ++++ RBC: 2-4 / HPF Glucose: negative RBC: 0-3 / HPF
Bilirubin: negative Pus Cell: 50-60 / HPF Bilirubin: negative Pus Cell: 50-60 / HPF
Ketone: negative Yeast Cell: few Ketone: negative Yeast Cell
Blood: negative Squamous Cells: few Blood: negative Squamous Cells: few
Protein: ++ Renal Cells: +++ Protein: trace Renal Cells
Urobilinogen: negative Bacteria: +++ Urobilinogen: negative Bacteria: ++
Nitrite: ++ Mucus Threads: + Nitrite: ++ Mucus Threads: few
Leucocyte esterase: ++ Crystals: Leucocyte esterase: ++ Crystals:
Amorphous urates: few Amorphous urates: +
Uric Acid Uric Acid:
Calcium Oxalate Calcium Oxalate
Amorophous PO4 Amorophous PO4
Triple PO4 Triple PO4

Diagnosis: Acute Pyelonephritis and Diabetes Mellitus Diagnosis: Urinary Tract Infection (E. Coli)